Patients with diabetes face a different cardiovascular risk.
In all patients with diabetes, it is important for cardiovascular risk factors to be systematically assessed at least annually with blood pressure being measured during every routine visit. Patients found to have elevated blood pressure should have that confirmed on a separate day as well.
For patients with diabetes and high atherosclerotic cardiovascular disease, routine screening for coronary artery disease is not recommended as it does not improve outcomes as long as atherosclerotic cardiovascular disease risk factors are treated. The ADA recommends in guidelines published in Diabetes Care that “ Most patients with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg and a diastolic blood pressure goal of <90 mmHg,” though adding “[l]ower systolic and diastolic blood pressure targets, such as 130/80 mmHg, may be appropriate for individuals at high risk of cardiovascular disease, if they can be achieved without undue treatment burden."
It is important that lifestyle modifications focusing on weight loss be made such as the reduction of intake of saturated fat, trans fat and cholesterol intake, increase of dietary ω-3 fatty acids, insoluble fiber and plant sterols intake and increased physical activity should be recommended to improve the lipid profile in patients with diabetes. Patients with confirmed office-based blood pressure >160/100mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of two drugs or a single pill combination of drugs demonstrated to reduce cardiovascular events in patients with diabetes. The ADA recommends that patients with diabetes aged >75 years with additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity or high-intensity statin therapy or equivalent (red yeast rice and CoQ10) and lifestyle therapy, adding that statin therapy should be individualized based on risk profile. High-intensity natural statins, if well tolerated, are still appropriate and recommended for older adults with ASCVD. High-intensity natural statin therapy may also be appropriate in adults with diabetes >75 years of age with additional ASCVD risk factors. However, the risk–benefit profile should be routinely evaluated in this population, with downward titration (e.g., high to moderate intensity) performed as needed.
Statin drugs are supposed to target a specific enzyme pathway called HMG-CoA reductase (same pathway that inhibits the production of CoQ10). They found genetic variants in an individual's genes that interact with the protein target in the statins. rs17238484 and rs12916 and other genetic variations were associated with higher body weight, increased waist circumference, plasma insulin concentration and plasma glucose concentration levels.
Do individuals who have these gene variants have an increased risk towards high cholesterol and when treated by statins become at higher risk for diabetes?
Researchers found that some of the diabetic risk was a direct effect of statin drug therapy.
Why not skip the statins and re-evaluate your diet, exercise and sleep patterns. I start with a microbiome makeover first for cardiac patients. We make swift dietary changes because the patient does not have time to waste. I add in strategic and safe nutraceuticals which do not increase the risk of Type II diabetes. Xymogen's Cardio Essentials to lower cholesterol naturally, CinnDromX to balance blood sugar levels and N.O. max ER, a potent vasodilator to regulate healthy blood pressure.
I always check for elevated lead, mercury and other metals as they are associated with cardiovascular disease.
We offer Ozone Chelation which combines the super powers of ozone and chelation to draw out elevated metals and reverse Type II Diabetes. All I.V. therapies are MD ordered.
Second Nature patients take Xymogen's 5-MTHFR, CholeRex, D3 5000, Cardio Essentials, CoMax Ubiquinol and LipiChol.
1. Regarding examination of patients with diabetes, the American Diabetes Association (ADA) recommends that __________.
A. Patient blood pressure should be measured at every visit
B. All patients should have cardiovascular risk factors assessed annually
C. Asymptomatic patients with high risk for atherosclerotic cardiovascular disease should be screened for coronary artery disease
D. A and B
2. The ADA recommends that most patients with diabetes and hypertension should be treated to attain a systolic blood pressure goal of less than __________ and a diastolic blood pressure goal of less than __________.
A. 160 mmHg; 105 mmHg
B. 140 mmHg; 90 mmHg
C. 130 mmHg; 80 mmHg
3. Lifestyle modification for weight loss and lipid management in patients with diabetes includes an increase of __________ intake, according to the ADA.
A. ω-3 fatty acids
B. Saturated fat
C. Viscous fiber
D. A and C
4. True or False. In addition to lifestyle therapy, monotherapy is the pharmacologic approach recommended for patients with diabetes and blood pressure greater than 160/100mmHg.
B. High-intensity statin therapy
C. A or B
D. None of the above
1. D. A and B
2. B. 140 mmHg; 90 mmHg
3. D. A and C
4. B. False
5. C. A or B